CENTRAL INSTITUTE OF PLASTICS ENGINEERING & TECHNOLOGY

(CIPET)

APPLICATION FORM FOR TECHNICAL POSITION

1. Post applied for

Post

Area of Specialization
(tick whichever is applicable)

(a) Graduate Engineer Trainee - G.E.T

Plastics Processing / Tool Room / Skill development

2. Full Name
(in block letters)
3. Date of Birth

Blood Group

4. Community
(SC/ST/OBC/GEN)
5. Whether Physically Challenged

Yes

No

If yes, state % of disability

(certificate to be enclosed)
6. Sex

Male

Female

Others

7. Marital status

Married

Single

Others

8. Nationality
9. Mother tongue

Religion

10. (a) Name and Address of Mother & Father

(b) Name of Spouse (if applicable)

(c) If spouse is employed,
Give employment details/place
11. Postal address for correspondence
with pincode

Telephone Land Line

Mobile

E-mail
Nearest Relatives Mobile Number

A)
B)

12. Postal address of the present employer

with pincode
WEBSITE:

13. Permanent Address

Place of Upbringing / Hometown:

14. Were you at any time declared medically unfit; asked to submit your resignation; discharged
or dismissed from Govt./Semi-Govt./Autonomous Body or Private Service?

If yes, give details in a separate sheet.

15. Have you ever faced any Vigilance Enquiry or enquiry by anti-corruption bureau/Central
Bureau of Investigation or any other Investigative Organization
Yes

No

If Yes: Please indicate in brief, the details of the Vigilance Enquiry and outcome thereof in
separate page
16. Academic Qualifications:
(Please attach photocopies of Degree Certificates including Date of Birth proof only. Copies
of semester-wise mark sheets need not be attached)
Give particulars in a chronological order starting with SSLC (Xth Std) School Certificate

Sl.
No.

2
3

Name of Course /
Degree /
University /
Board

Subject/
Specializ
ation

Pass
Mode of study Division
Full Time /
(Ist or
Part time /
IInd or
Correspondence
IIIrd)
Class

% of
Marks/
CGPS

Duration of
Degree / PG
(whether 1 Year of
yr. or 2 yrs. Passing
or 3 yrs.
course

17. Employment details: (Give particulars in ascending chronological order starting from the first
employment Mention Post Qualification experience only)

Sl.
No.

Organization Name /
Employer

Position
held /
Designation

Pay Scale
& Gross
Salary

Place / State
of
Employment

Period of
Employment
(Month/Year)
From

18. Any Other Higher Qualification

Sl.No.
1.

2.

Degree

University

To

19. If you claim work Experience in the relevant area of requirement, please furnish clear details
below:

20. Any other information which you would wish to disclose / highlight with reference to the
relevant job requirements :

21. Reference

Responsible persons not related to the applicant but closely acquainted with the applicant
Name and Designation

Address

Phone:
Email:

Phone:
Email:

22. Last drawn pay details (Salary Certificate to be attached)

Pay in the Pay Band Rs.
Grade Pay

Rs.

D.A./I.D.A.

Rs.

H.R.A.

Rs.

Any Other All.(1)

Rs.

Any Other All.(2)

Rs.

Total Gross Salary

Rs.

Scale of Pay:

23. Notice period / No. of days likely to be availed for relieve from parent organization on
selection:

24. (a).Details of relatives working at CIPET, if any :

(b) Any other information you may like to furnish to CIPET:

25. Social / Political / Religious Affiliations of the Candidate if any, Mention the name and clear
details about the affiliations:

26. Copies of documents enclosed:

(i)
(ii)

(iii)
(iv)
(v)
(vi)
------------------------------------------------------------------------------------------------------------------------------DECLARATION
I declare that the Entries made in the Columns of this proforma are correct and true to the best
of my knowledge and nothing has been either concealed or misrepresented by me. In case of
any misrepresentation, I understand that employment if any gained, is liable for termination.

Place:

Signature

Date:
------------------------------------------------------------------------------------------------------------------------------Forwarding of Application through proper channel: (To be filled in by the forwarding
authority).
(Applicable for Candidates from Central/State Govt./PSU/Autonomous/Quazi-Govt. only)
Date: ________
Forwarded to the Central Institute of Plastics Engineering & Technology (CIPET)
The applicant has been working in this Office / Organization / Institute / University as
________________________________ since ________________ and is still in service. We
have No Objection to his/her candidature being considered for the post he / she is applying.

Place:

Signature
(Name & Designation with seal)

N.B.: 1). Use separate sheets wherever necessary while filling application form above.
2). All entries in this application form shall be neatly typed.